Provider Demographics
NPI:1659073005
Name:KULAGE, GRACE HELEN
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:HELEN
Last Name:KULAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-1943
Mailing Address - Country:US
Mailing Address - Phone:225-772-0800
Mailing Address - Fax:
Practice Address - Street 1:7742 OFFICE PARK BLVD STE C2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-8636
Practice Address - Country:US
Practice Address - Phone:225-448-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health